Provider Demographics
NPI:1922195502
Name:HULL, SHERIDAN R (CNP)
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:R
Last Name:HULL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8930
Mailing Address - Country:US
Mailing Address - Phone:330-296-2752
Mailing Address - Fax:
Practice Address - Street 1:24165 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1516
Practice Address - Country:US
Practice Address - Phone:440-250-3560
Practice Address - Fax:440-617-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner